Frequently Asked Questions
Click on any of the subjects below to have it expanded and learn more about it.
If you have further questions or would like more information on any of these topics, don’t hesitate to contact us. Dr. Cottam will be happy to talk with you!
What Is a Pediatric Dentist?
“Pediatric dentist” is a title reserved for dentists who complete 2-3 years of residency training after their standard dental school training. Like a pediatrician, they develop the skills to care for the changing needs of infants, children, and teens. Many pediatric dentists’ offices are decorated with children in mind, and provide child-friendly rewards and entertainment options. Having other kids around also helps many children feel more comfortable.
Pediatric dentists are able to examine and treat children in ways that make kids feel comfortable and less fearful. Pediatric dentists are comfortable using a wide variety of techniques, from specific ways of interacting with your child to using sedative medications, including IV sedation and general anesthesia when truly necessary, to help young or frightened patients be comfortable and cooperative. Some pediatric dentists, of which Dr. Cottam is one, are also trained to provide care for children who have additional psychological, medical, or behavioral considerations.
Why are baby teeth so important?
Primary teeth, or baby teeth, are temporary teeth and have usually fallen out by the time a child is between 11 and 13. Nevertheless, during the decade they are in your child’s mouth, primary teeth are an important part of the body! (In fact, some people do not have all of their permanent teeth. In these cases, a primary tooth may need to serve a person for their whole life!)
Some of the things primary teeth do are:
- Guide the permanent teeth into place
- Contribute to proper growth of the jaw and facial muscles
- Help with eating and speaking
- Provide shining smiles, attractive appearance, and self-confidence
Advanced disease in primary teeth (for example cavities) can be very painful. It may cause problems in the growth and development of the permanent teeth, as well as affecting eating, sleeping, school performance, and decreasing quality of life.
Eruption of your child’s teeth
Children’s teeth begin forming in the jaws before birth. The first teeth to erupt through the gums are usually the lower central incisors; this can happen as early as four months old! Most children have all their primary teeth in by the time they are three, though the order and specific timing varies quite a bit. The first permanent teeth to erupt are the permanent molars and lower central incisors (which will cause your child’s first primary teeth to begin falling out). This process continues into the late teens or early twenties. Adults may have as many as 32 teeth, including the wisdom teeth.
Gum Disease: Not Just for Adults
When most people think of “gum disease” they think of receding gums and loose teeth in adults. The fact is, though, that anyone who has gums is susceptible to gum disease. Pretty safe to say that includes just about everyone we know.
If your child complains of sore or bleeding gums after brushing or flossing, he may have early-stage gum disease, also called gingivitis. Think about what would happen if your child cuts his hand and refused to keep the wound clean: it would get infected, and start swelling, bleeding, and hurting. Gum tissue is no different. When teeth are not consistently cleaned, food and bacteria collect around the gums. The bacteria lead to swollen gums that are prone to bleeding and may even be painful. The gums actually loosen around the teeth, creating pockets where more bacteria can survive. Eventually, this process leads to bone loss and poorly supported, loose, or missing teeth.
Symptoms of gum disease include:
- Gums that bleed when brushed or flossed
- Swollen gums or bright red gums
- Bad breath
- Pus between gums and teeth
Prevention and healing:
- Regular visits with your child’s pediatric dentist
- Regular professional cleanings
- Effective brushing 2-3 times per day
- Effective flossing once a day
- Eat a healthy diet
- Older children and teens can use an anti-bacterial mouthwash
If your child has gingivitis caused by inconsistent or ineffective teeth cleaning, he may complain of discomfort or bleeding for a few days when brushing and flossing. Once you begin a habit of consistent, effective oral hygiene, the gums will begin healing and you will notice that the bleeding and the complaining both diminish.
First Dental Visit
The American Academy of Pediatrics, the American Dental Association, and the American Academy of Pediatric Dentistry encourage parents to find a dentist to be their oral health advisor by the time the child is one year old. Children who have an established relationship with a dentist, also called a “dental home”, are much more likely to receive appropriate preventative and routine oral health care. Children who do not have a dental home all too often end up in the emergency room for their first dental visit. We very much want to help you avoid that experience.
Whether your child has been to a dentist before, or this will be their first visit, some children (and even parents) may be anxious. We like to keep you informed about what to expect, as well as give you some preparation tips, to help make your child’s first visit as pleasant and positive as possible.
What to expect on your first visit:
- Thorough, gentle examination of facial balance, jaw relationship, bite, oral muscles and soft tissues, gums, and teeth.
- Digital x-rays.
- Professional teeth cleaning.
- Discussion of your child’s oral heath, a description of what Dr. Cottam saw during his examination, and his recommendations for helping your child attain the highest level of health possible.
- Teaching about how you and your child can prevent disease at home.
- You can learn more about these topics by reading the Prevention section in the Dental Information Center.
Tips for a pleasant dental visit:
- Be positive and keep it low key. Treat the visit as a routine event. Tell your child that the pediatric dentist is a doctor who makes sure our teeth are healthy.
- Make the appointment at the time of day your child is happiest.
- Use the dentist’s and staff’s names to help your child become familiar with us and understand that we are just people.
- Bring your child in for a tour a few days before the appointment. Help build a sense of familiarity.
- Ask us what to expect.
- Talk to your child about what to expect. Avoid using words like “needle”, “drill”, “pull”, “shot” and “hurt” that cause unnecessary fear. We make a practice of using words that explain to the child what is going on but are comfortable and non-frightening.
- Explain to older siblings that you need their help to make the visit comfortable. They should not use those words to try to scare little brothers and sisters either.
- Don’t make promises you don’t have any control over, such as “It won’t hurt.”
- Don’t use the dentist as a threat to convince your child to do something, such as “Brush your teeth or the dentist will give you a shot.”
Obstructive Sleep Apnea in Children
Children frequently exhibit altered breathing patterns during sleep, ranging from snoring to obstructive sleep apnea. This range of problems is referred to as “sleep-disordered breathing”. Snoring, on one side of the spectrum, is a fairly innocuous, but certainly annoying, social nuisance. On the other side of the spectrum lies apnea, a temporary pause in breathing during sleep, that occurs in approximately 10% of children and can have detrimental health consequences.
Whereas most children will snore mildly now and then, children with sleep apnea generally have regular, loud, continuous snoring. Other symptoms of sleep apnea include:
- Pauses in breathing followed by gasping or choking
- Mouth breathing
- Frequent nighttime awakenings
- “Failure to thrive”
- Bed wetting
- Daytime behavioral or cognitive problems, including hyperactivity, irritability, poor academic performance, and difficulty maintaining attention
Sleep apnea in children is usually caused by enlarged tonsils and adenoids. It is not treated directly by the pediatric dentist but does change the available range of therapies that the dentist may suggest for your child. Please discuss any of these symptoms with Dr. Cottam. Not only can we adjust your child’s dental therapy, but we can help you contact the physicians who can best advise you about the sleep apnea itself.
Severe blow to the head
Take your child to the hospital emergency room immediately, especially if your child was knocked unconscious or has been vomiting.
Possible fractured or broken jaw
Take your child to the hospital emergency room immediately.
Rinse your child’s mouth with warm water and use a piece of floss to remove any food or debris that may be stuck between the teeth. If the pain persists, contact us during regular business hours. Do not place aspirin or heat directly on the gum or achy tooth; these can cause further damage and more pain. If your child’s face is swollen, apply cold compresses and contact us immediately.
Cut or bitten tongue, lip, or cheek
Use a cold compress to help control swelling. If there is bleeding, apply firm, constant pressure. If the bleeding cannot be controlled, contact a physician or visit a hospital emergency room. If the cut was the result of an accident, contact us as well, so we can be sure there has been no damage to the teeth or jaws.
Knocked out or loosened tooth
Permanent teeth: Find the tooth. Do not handle it by the root; only touch the crown (the part that would be visible in the mouth). Rinse it gently in water, but do not scrub it or use any kind of soap. Check the tooth for fractures; if it is sound, try to reinsert the tooth in the socket. Hold it in place by biting on a piece of gauze. If you cannot put the tooth back in the socket, place it in a cup of cold milk or saline contact solution. Call us immediately; time is critical in saving the tooth!! If your child is a patient of record, you may call Dr. Cottam directly on his cell phone: (801) 891-1882.
Primary (baby) teeth: Contact us during business hours. This is not usually an emergency. In most cases, no treatment is necessary, though we would like to examine the injury so we can let you know about the healing process, and advise you of any possible damage to nearby teeth or bone.
Chipped or fractured tooth
Call us immediately. Speedy action can prevent infection, reduce pain, and spare the tooth from extensive therapy. Apply cold compresses to control swelling. Try to locate any tooth fragments, and bring them with you to our office.
Children deserve to experience a gentle, caring approach to their dental care. A positive dental experience will help them build confidence and knowledge, setting a great precedent for their future dental health. Your child will always be grateful for the gift of a beautiful, healthy smile.
Dental examinations help to diagnose disease before it becomes hazardous to your child’s health. In addition, regular examinations can save you money by addressing problems while they are small and before they become expensive, or in some cases impossible, to repair. Your child’s dental examinations generally include the following:
- Oral cancer screening.
- Evaluation of growth and development.
- Orthodontic needs assessment.
- Gum disease evaluation.
- Visual examination of tooth decay.
- Examination of diagnostic x-rays to see cysts, tumors, invisible decay and other problems that can’t be seen by the naked eye.
- Evaluation of status of current restorations (fillings and others).
- Consultation regarding your child’s home care and personalized program to prevent oral disease.
We cannot express enough how important it is to see your pediatric dentist regularly. Preventing disease is always better than treating disease.
In cooperation with excellent care at home, professional cleanings (dental prophylaxis) form the foundation for preventing gum disease and tooth decay. In a professional cleaning, your child’s dental team will:
- Remove plaque from the teeth — plaque is a sticky substance made up of food, saliva and bacteria. Plaque sticks to teeth and causes tooth decay and gum disease.
- Remove calculus (tarter) above the gum line — calculus is plaque that has hardened on the tooth surface and is difficult to remove. (Calculus below the gum line indicates gum disease and requires a different procedure to remove it.)
Dental x-rays or radiographs are very important. They allow Dr. Cottam to see things about your child’s oral health that cannot be seen by the naked eye. Cysts, cancerous and non-cancerous tumors, invisible decay that occurs between teeth, and the location and orientation of teeth that haven’t grown all the way in are some of the things that we can see by using “tooth pictures.” Early diagnosis and treatment is not only less invasive, it costs less. Who doesn’t like to save money? In some cases, where dental x-rays show the location of cancerous growths, x-rays can even be responsible for saving a child’s life.
Are Dental X-Rays Safe?
Modern dental x-ray machines are very safe. We use only state-of-the-art, low radiation equipment. The amount of radiation exposure your body receives on an airplane flight from Los Angeles to New York far exceeds the amount of exposure your child receives from our modern dental x-ray machine. Contrast this minimal exposure with the risk of not finding an illness until it is too late, and you can see why we prescribe regular diagnostic x-rays.
Seal Out Decay
What’s Going On?
Normal pits and grooves on the chewing surface of back teeth can trap food and bacteria. These pits and grooves are often so narrow that normal brushing or rinsing cannot clean them.
What Do We Do About It?
A sealant is a clear or tooth-colored plastic material that is painted onto the tooth surface to “seal” the pits and grooves and protect against decay. They are generally applied to children’s first permanent back teeth. They may also be recommended for other permanent teeth as they come in.
Sealants are an excellent way to protect chewing surfaces of teeth from decay. They are a much better financial investment than treating decay after it has started. They are also much more comfortable and faster than a filling.
Sealants are not permanent. They generally last about five years with normal wear but can wear off or chip off earlier in certain instances. Also, sealants do not prevent decay between teeth or the onset of gum disease, so regular home care, good diet, and regular dental visits are still important.
There are no appropriate alternatives to sealants. If a tooth has decay, it will need a filling or other restoration.
Adequate home care is imperative if you want to maintain a healthy, beautiful smile and prevent costly dental treatment in the future. The goal of home care is to regularly remove the sticky film of bacteria called plaque from your child’s teeth. Remember, “Clean teeth do not decay!”
“Cleaning” and “brushing” aren’t the same thing
Until approximately the age of 9, children do not have the manual dexterity and coordination it takes to effectively clean their teeth. They certainly need to practice, but an adult should be ultimately responsible for hygiene. As Dr. Cottam likes to say, “Children brush teeth. Parents clean teeth.”
What toothpaste should I use for my child?
There are a dizzying number of toothpastes from which to choose! Some tooth pastes and polishes contain harsh abrasives that can damage young smiles. Select a tooth paste that has been approved by the American Dental Association as shown on the box and tube – these have undergone testing to be sure they are safe.
Children should spit out the toothpaste after brushing to avoid getting too much fluoride. Ingesting excessive fluoride can lead to a condition known as fluorosis. If your child is too young, or otherwise unable, to spit, consider using fluoride-free toothpaste, no tooth paste, or only a smear of tooth paste on the brush. Children at higher risk for decay (including teens wearing braces) may use a prescription strength fluoride toothpaste. Discuss these options with Dr. Cottam to determine which is right for your child.
Brush your child’s teeth twice daily using a soft tooth brush. Gently move the brush in a small, circular motion at a 45 degree angle to the gum line. Count 10 circles on the front, back, and top of each tooth. You should also brush your child’s tongue to remove the bacteria that cause bad breath. You can use any soft bristled, ADA-approved tooth brush. We also recommend the use of modern electric tooth brushes such as Sonicare and Braun.
Effectively removing plaque that has formed on teeth takes approximately two minutes. Many of our patients use a kitchen timer or a flip-over sand timer on the bathroom sink to practice what two minutes feels like. Some of our really tech-savvy kids use their smart phones!
Your child’s hygiene will be evaluated at his/her examination and effectiveness discussed.
After brushing, your child should spit out the excess toothpaste, but rinsing with water after brushing is not necessary. A water rinse removes the lingering toothpaste flavor, but also removes the tooth-strengthening fluoride in the toothpaste. We recommend either of the following, which will allow fluoride to work a little longer to protect your child’s teeth:
- After brushing, spit, but do not rinse.
- After brushing, spit, then rinse with ACT fluoride rinse or other fluoridated, alcohol-free mouth rinse.
People at high risk for oral disease (which includes many children and everyone wearing braces or other oral appliances) should rinse with water after every meal if brushing teeth is not practical.
Once teeth are touching one another, toothbrush bristles are too large to clean between them. Floss is the only thing that has been shown to do a really good job cleaning these areas. Take 12″ to 18″ of dental floss and wrap it around the middle finger of each hand. Pull the floss tightly, and then use your thumb and forefingers to slide the floss gently between each set of your child’s teeth. Curve the floss around each tooth and move the floss up and down along the tooth, going as low as you can comfortably reach under the gum line. Flossing aids are available to assist children with holding the floss. Many parents, including Dr. Cottam himself, also find these aids helpful for flossing their own and their children’s teeth, too. He would be glad to tell you what he uses with his own children – just ask!
My child won’t brush!
Dr. William Berlocher, a veteran at working with children and a past president of the American Academy of Pediatric Dentistry says: “Children who have discovered they have some control in their lives and are resistive to their parent’s direction and instruction can be a more challenging issue. A term that I’ve found to be extremely useful in these situations is ‘cheerful persistence.’ First of all, parents need to be positive and keep a smile on their face when working with their child. Parents give many nonverbal cues to their children. If you go into a tooth-brushing session looking like you’re going to war, more than likely it will be just that! Secondly, oral hygiene is something that works only if it is undertaken on a regular basis. Therefore, daily brushing is a must. Avoiding tooth brushing because of the potential for a clash between a child and parent dramatically increases the potential for development of dental cavities.”
Dr. Cottam can show you how to position your young child to make tooth brushing sessions more manageable. If you dread this part of the daily routine, ask for some tips when you come in to visit us!
Good Diet: Healthy Teeth
Healthy eating habits help keep teeth in good condition. Like the rest of the body, the mouth needs a well-balanced diet to stay fight disease and stay healthy. Children need a variety of foods from all five food groups. Most snacks that children eat lead to cavities.
The amount of time a child’s teeth are exposed to food, the higher the risk for decay. For example, do you think that a caramel or a cracker is more likely to lead to cavities? Most people say the caramel, but that actually isn’t true. The caramel dissolves and is gone relatively quickly, but the cracker gets stuck in the teeth, providing food for the cavity-causing bacteria for a long time. By the same token, children who snack constantly are much, much more likely to have problems, even if the snacks are healthy foods like fruits, veggies, or milk.
A good rule of thumb is to establish several specific snack times throughout the day. Food should be offered only at meals or snack time, rather than constantly all day long. At snack time, choose nutritious foods such as vegetables, yogurt, and cheese which are healthier for both the teeth and the body.
Processed beverages and juices have become very popular in recent years. When available to children throughout the day, they can cause rapid tooth decay. The American Academy of Pediatrics recommends that infants not be given fruit juice at all! Children ages 1 to 6 should have no more than 6 oz of juice per day (about 3/4 cup). Older children should have no more than 12 oz (about 1 1/2 cups). If you choose to give your child juice, it is best to do so only at meal time.
Fluoride is a natural element which has been shown to make teeth more resistant to decay. It can even help heal damaged teeth if the disease is caught early enough! However, too little or too much fluoride can be detrimental to teeth and overall health.
Too little fluoride will leave teeth more vulnerable to decay. Too much fluoride, especially in young children, can lead to a condition called fluorosis, which causes white, chalky spots on permanent teeth. In severe cases, it can even cause brown or black discoloration.
To protect your child’s teeth, we provide fluoride varnish to your child at regular cleaning visits. At home, you can help ensure your child receives the appropriate amount of fluoride by using an ADA-approved toothpaste (see Home Care in the Prevention section for more information about selecting a toothpaste) and by allowing your child to drink water with fluoride in it. Bottled water sometimes has fluoride, and sometimes does not; it’s very difficult to tell because bottlers are not always required to disclose whether or how much fluoride is in their water. The best practice is to provide either tap water (which has fluoride here in Salt Lake City) or bottled water that specifically states on the bottle that it contains fluoride.
There are many more sources of fluoride in most children’s diet than most parents realize. Some of the ones to be aware of are:
Too much toothpaste – two and three year olds may not be able to spit out the toothpaste after brushing. Ingesting too much toothpaste during brushing is the single greatest risk factor for fluorosis. To prevent this, put no more than a smear of toothpaste on young children’s toothbrushes. Older children who are able to spit should receive no more than a pea-sized amount of toothpaste.
Powdered baby formula – many powdered formulas contain fluoride. Contact the manufacturer to find out whether yours does. If you use a powdered formula that contains fluoride, reconstitute it with water that is labeled fluoride-free. Here in the Salt Lake area, our tap water has fluoride in it. For the vast majority of children, that’s a very good thing, but it could be too much for your infant if she is also getting fluoride from powdered baby formula. This is particularly important for children under 6 months old.
Other foods – soy-based infant formula, infant dry cereals, creamed spinach, infant chicken products, white grape juice, juices bottled in cities with fluoridated water and many other foods sometimes contain high levels of fluoride. If you are concerned, contact the manufacturers of these products to ask what is in them.
Prescribed vitamins – some vitamin supplements prescribed for young children include fluoride. If your child has been prescribed one of these, be sure to let us know so that we can help you evaluate your child’s fluoride intake.
Xylitol: Reducing Cavities
Have you heard the rage lately about xylitol, a natural non-sugar sweetener? Here’s the skinny.
Xylitol is found widely in nature. Most fruits and berries contain xylitol, as do mushrooms, lettuce, hardwoods, and corn cobs. A good number of studies have demonstrated that eating the appropriate amount of xylitol can reduce new tooth decay and even help reverse early tooth decay. Xylitol provides protective benefits that enhance the other preventative methods we use in our office.
Studies show the amount of xylitol that most consistently produces anti-cavity effects is between 4 and 20 grams per day, taken over 3-7 servings. More xylitol can cause digestive difficulties, and less does not seem to make a difference for cavities. One study, for example, demonstrated that moms who chewed two pieces of xylitol gum (about 2g of xylitol) three times per day starting three months after delivery and continuing until the child was two years old, reduced the amount of decay in their child’s mouths by 70%. How cool is that? Moms chewing gum reduced their children’s cavities to almost a quarter of what it would have otherwise been!
Ask at your local grocery or health foods store to find products containing xylitol. You can also find xylitol gum and mints online. A good rule of thumb is that unless xylitol is the first or second ingredient on the label, the item probably does not have enough xylitol to fight cavities. If you would like help evaluating your xylitol intake or finding useful products, please ask our friendly staff!
One of Dr. Cottam’s passions is keeping children and teens safe while participating in sports. Dr. Cottam has trained with leading oral surgeons and endodontists (experts in keeping teeth alive!) and is excited to share the latest in sports dentistry and sports safety with you and your children.
Athletic Mouth Guards
When a child begins to participate in organized sporting activities, injury can occur. Even so-called “non-contact sports” have a surprisingly high rate of oral and facial injuries. For example, more high school athletes, male and female, suffer mouth and facial injuries while playing basketball than any other sport. (That distinction used to belong to football, before football players were required to wear mouth guards.) Mouth guards protect not only the teeth, but also the soft tissues of the lips, cheeks, and tongue. A properly fitted mouth guard can even help decrease the risk of jaw fractures and concussions.
Different brands and types of mouth guards vary in terms of comfort, protection, and cost. Most sporting goods stores sell pre-formed guards and “boil-and-bite” guards for a very modest cost. Because the store-bought guards often are bulky, may not fit well, and interfere with the athlete’s speech, many parents tell us that they tend to get left in the locker room. You can also choose a customized mouth guard made by a dental professional, such as Dr. Cottam. While these generally cost a bit more than the in-store ones, they are more comfortable and much more effective at preventing injuries.
Your child should wear a properly fitted mouth guard whenever he or she is participating in an activity with a risk of falls or head contact. Such activities include (but are certainly not limited to) football, baseball, basketball, soccer, hockey, skateboarding, gymnastics, cheerleading, volleyball and wrestling.
Dr. Cottam can even customize your child’s guard with decals, team name, colors, sparkles, a break-away strap, and more!
Sports Drinks: Beware!
Sometime in the recent past, it became almost accepted in our culture that children need sports drinks to properly hydrate after physical exercise. Soon after that, children started drinking sports drinks just because they were thirsty at any time of day.
While elite athletes may benefit from the electrolyte balancing in sports drinks (indeed, that’s what they were originally developed for), children and teens, even those participating in sports, need water for proper body function. Sports drinks provide way too much sugar and acid.
To minimize dental problems, children and teens should drink water before, during, and after sporting activities.
If sports drinks are consumed:
- Reduce the number of drinks.
- Do not swish the drink. Just swallow it.
- Rinse with water after drinking a sports drink.
- Use water for cleaning mouthguards. Never rinse a mouth guard in a sports drink.
One of the most frequent questions in our office is, “Why does my child grind her teeth at night? It’s so loud!” Nobody really knows what causes tooth grinding, or “bruxism”. There are many theories about why children grind their teeth. One is that primary teeth are relatively flat, making it easier for growing jaw muscles to move from side to side. Another idea is that recent stressors in the child’s life, like a new school year or a family move, may lead to more tooth grinding. A third idea is that grinding is a way for the child’s body to equalize pressures in the inner ear (similar to how many people chew a piece of gum during take-off and landing in an airplane).
Whatever the cause, the good news is that treatment is only rarely necessary. Bruxism does not often cause excessive damage to primary teeth, and children tend to outgrow it before permanent teeth or jaw muscles are damaged. Bruxism generally declines starting at about age 6, and is completely outgrown between 9 and 12.
Sucking is a natural reflex, and many infants and young children suck on pacifiers, fingers, thumbs, or other objects. Sucking may provide comfort, help a child feel secure, or relieve stress; it is also relaxing and may help a child get to sleep.
Sucking habits that persist beyond the eruption of permanent teeth, or that are particularly vigorous can alter the development of the jaws and the growth of the teeth. Children who rest their thumbs in their mouths, rather than sucking intensely, and children who stop the habit early are less likely to have problems. Usually children stop between the ages of two and four; peer-pressure may help some older children stop.
Some suggestions to help your child overcome a sucking habit:
- Children often suck their thumbs when feeling insecure. Focus on addressing the cause of the anxiety, rather than on the sucking behavior.
- Children who are sucking for comfort will feel less of a need when their parents are attentive to providing that comfort.
- Reward a child who does not suck his thumb during a difficult time, for example a separation from a parent. That child has successfully dealt with the stress in another way, and you can let him know how proud of him you are.
- Dr. Cottam can encourage your child and explain what could happen if she continues to suck her thumb.
- If your child wants to stop, and needs some help, a bandage over the thumb may be just the thing. For some children, we may also recommend an oral appliance or other aids.
Dr. Cottam would be happy to discuss with you any concerns about your child’s sucking habits.
Sucking is a natural reflex, and many infants and young children suck on pacifiers, fingers, thumbs, or other objects. Sucking may provide comfort, help a child feel secure, or relieve stress; it is also relaxing and may help a child get to sleep. Sucking habits that persist beyond the eruption of permanent teeth, or that are particularly vigorous can alter the development of the jaws and the growth of the teeth.
Pacifiers affect the teeth and jaws in essentially the same way as thumb sucking, and should not be viewed as being “safer” or less likely to cause problems. However, pacifier use is much easier to control and modify, and is an easier habit to discontinue when the time is right. A pacifier should never be dipped in honey or sugar to encourage a baby to take it; this can lead to severe dental disease, as well as making the sucking habit more difficult to control.
If you notice that your child cannot bite his front teeth together, please call us. This may be a side effect of intensive pacifier use.
Dr. Cottam would be happy to discuss with you any concerns about your child’s sucking habits.
Pulpotomy (Baby Root Canal)
Whats Going On?
Decay that has reached the nerve/pulp of the baby tooth.
What Do We Do About It?
Like adult root canals, the dentist will access the nerve chamber of the tooth, and remove some of the nerve/pulp of the tooth. Unlike adult root canals, this is a very short procedure, as only part of the pulp needs to be removed, and does not require the time-consuming filing of adult root canals.
- If the tooth has been symptomatic, this procedure will likely alleviate the pain.
- Allows for the tooth to be preserved until it is ready to fall out naturally.
Pulpotomies have a 90% success rate. Occasionally, the nerve of the tooth is so badly damaged that it does not respond to pulp therapy, resulting in the need for extraction of the offending tooth. Certain circumstances increase the likelihood of failure with pulpotomies. Dr. Cottam will discuss your child’s situation with you during diagnosis.
The only alternative to a pulpotomy is extraction and placement of a space maintainer. However, if it is possible to save the baby tooth, a pulpotomy is the best choice because it preserves the appropriate spacing for the adult dentition and allows the child to continue to use the tooth.
What’s Going On?
Developing malocclusions, or “bad bites”, can be recognized as early as 2-3 years of age.
What Do We Do About It?
Stage I – Age-appropriate therapy. This stage used to be called “early treatment”, but it isn’t really “early”. Often, steps can be taken at this young age to reduce the need for extensive orthodontic treatment when the child is older.
Stage II – Mixed dentition. This stage usually encompasses the ages of 6 – 12, beginning with the arrival of your child’s permanent back molars, and upper front teeth.
Stage III – Adolescent dentition. This stage deals with the final development of the jaw and bite relationships.
Stage I – At this stage we are primarily concerned with underdevelopment of the jaws, premature loss of baby teeth, and side effects of thumb or pacifier sucking habits. Many times, though not always, therapy initiated at this stage can eliminate the need for or reduce the extent of future orthodontic and orthopedic treatment.
Stage II – When indicated, this is an excellent stage at which to start treatment because growing tissues are usually very responsive to orthodontic and orthopedic forces.
Stage III – Now that your child’s permanent teeth are all in, this is the time to make sure they are aligned properly for healthy long-term function and a good-looking smile.
Many orthodontic treatments require frequent follow-up visits so Dr. Cottam can make regular adjustments to your child’s appliance. The risk for tooth decay increases when orthodontic appliances are not kept very clean. After therapy is complete, teeth sometimes relapse, or move back towards where they were prior to treatment.
There are many different appliances that can be used to direct the growth of the jaws and teeth. Each has its own specific advantages and disadvantages. In some cases, deciding not to use orthodontic therapy can lead to the damage or loss of permanent teeth, while in other cases relatively little difference would be noticed. Your pediatric dentist will discuss the differences among alternatives in your child’s specific situation.
What’s going on?
When primary teeth (baby teeth) are lost early, the teeth next to the empty space tend to crowd in, taking up room that should have been available for a growing permanent tooth.
What do we do about it?
A space maintainer – a band with a small wire attached to it – is designed to hold the remaining teeth in position so that the permanent teeth can come in to the proper location.
Prompt placement of a space maintainer will give the permanent tooth the best chance of erupting in the mouth in the correct location. This will minimize orthodontic problems caused by premature loss of a baby tooth.
Your child will need to wear the appliance until shortly before the permanent tooth erupts. If not kept clean, decay can occur under the bands.
If a space maintainer is not placed, we must maintain a “wait and see” approach. Typically, the surrounding teeth will shift into the open area, making it difficult or in some cases impossible for the permanent tooth to erupt. This requires orthodontics to remedy. In severe cases, blocked out permanent teeth may need to be removed.
An inexpensive way to repair a small amount of tooth decay.
What’s going on?
Decay on a small portion of any tooth.
What do we do about it?
A composite filling is a tooth colored quartz-like material. After tooth decay has been removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.
Composite fillings are more than just attractive. They are also minimally invasive: less healthy tooth structure is removed to restore the tooth. Also, a sealant can be placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth. When a composite filling needs repair, it can be done relatively easily (unlike a silver filling).
Composite fillings can be subject to wear and tear from tooth grinding and from biting into or chewing on hard objects. They are not permanent, and may need to be repaired from time to time.
In cases of extensive decay, a crown or silver filling is a better option; these have been shown to protect the teeth better when a large portion of the tooth has already been damaged. If the decay is not treated, it will most likely increase in size and become a larger problem. Untreated decay and infection can damage developing permanent teeth.
Protect and maintain badly decayed or fractured teeth.
What’s going on?
- Badly decayed tooth.
- Fractured tooth.
- Tooth that needs to be protected and strengthened.
- Tooth has had a pulpotomy or baby root canal.
What do we do about it?
A crown (often called a cap) covers the tooth completely, providing unsurpassed protection and adding greatly to the tooth’s strength. Decay is removed from the tooth, the tooth is cleaned, and a preformed crown is placed over the tooth. Unlike adult crowns, in which the crown is made to fit the tooth, and which often require 2 appointments, children’s crowns are placed in one visit, because the tooth is prepared to fit the crown.
Crowns are incredibly strong and cover the entire tooth. This protects and strengthens the remaining tooth structure. They are the best chance for survival of a tooth that has been extensively damaged by decay or has had a baby root canal.
Crowns are excellent restorations and have few disadvantages. Most children’s crowns are silver in color; some do have white coatings, and these coatings often break off, exposing the silver underneath. Teeth that have had crowns are not immune to future disease and may need additional treatment.
If a tooth has sustained enough damage to require a crown, then the best prognosis for the tooth is to receive the crown. Placing a filling on a tooth that should have a crown will likely result in fracture, recurrent decay, and loss of that tooth. Removing the tooth, instead of placing a crown on it, may be considered, but is not usually recommended.
Most of the bleeding should have subsided by the time you have left the office. It is important to keep pressure on the extraction area for about 30 minutes after extraction. This can be done with the gauze provided when you left the office. If the site begins to bleed again, have the child bite on wet gauze for 10 minutes.
Swelling: Swelling after an extraction is usually due to your child biting the area that was anesthetized without realizing it. Place ice bags around the area if it is the day of the extraction. Call us to make an appointment to evaluate the severity of the swelling. If the swelling is rapidly progressing, call us as soon as possible.
Lip Biting After Treatments
Occasionally children will bite themselves in the area they were anesthetized without realizing it. The area can become discolored (yellow, white, or red) and rather painful. Your child will need to remain on a soft diet until the area heals to avoid re-injuring themselves. Give Children’s Motrin/Tylenol as needed for the pain.
If the area is swelling, please call us.
Infant Oral Health
Perinatal and Infant Oral Health
The American Academy of Pediatric Dentistry recommends that all pregnant women receive oral health care and counseling during pregnancy. Taking care of your own mouth, and learning how to take care of your baby’s, will be one of the best things you can do to promote your child’s long-term health.
Mothers with poor oral health may be at greater risk for pre-term birth and low birth rate, as well as greater risk for passing cavities on to the young child. Some helpful tips to reduce these risks:
- Visit your adult-care dentist regularly during pregnancy. If you do not have a dentist with whom you are comfortable, we would be happy to suggest some doctors we work with frequently.
- Remove plaque from your teeth by brushing and flossing every day.
- Eat a proper diet. Read “Good Diet = Healthy Teeth” in the Prevention section. Although written about children’s diets, the information is applicable to adults, too.
- The bacteria that cause cavities are contagious! Don’t share your utensils, cups, or food with children; they should have their own. Use water to clean your baby’s pacifier – don’t lick it.
- Consider using a xylitol chewing gum. (To learn more, read “Xylitol: Reducing Cavities” in the Prevention section.)
Teething and Sore Gums
Teething, the process of teeth coming through the gums and into the mouth, is different from child to child, both in the timing of the events and in how the child experiences them. Some babies get their teeth in very early, and some get them in late. Some babies appear very uncomfortable during the process, and some hardly bat an eyelash.
Here are some suggestions for helping babies, parents, and grandparents who are uncomfortable:
- Medical studies have not shown teething to cause diarrhea, fever, or rash. If these symptoms are present, do not assume the cause is teething. Contact your child’s pediatrician, especially if your child has a high fever or frequent diarrhea.
- Massaging the gums with your finger often helps calm the baby.
- Let the baby bite on a cool teething ring or a cool, wet washcloth. Many babies like putting new objects in their mouths, and this not only helps sooth discomfort, but it can be quite entertaining for some little ones.
- If your baby is old enough to eat solids, try offering chilled foods, like applesauce or yogurt.
- Use acetaminophen (Children’s Tylenol) or ibuprofen (Children’s Motrin or Children’s Advil). These are very common pain relievers that are quite safe when used at the recommended doses.
- If these methods don’t seem to do the trick, some parents try topical anesthetic gels to numb the gum tissue. Be careful, though, because too much gel can also deaden the back of the throat, leading to choking. There is also evidence that these topical anesthetics can trigger a rare, but potentially fatal, blood problem called methemoglobinemia.
- Some parents swear by herbal medications. Many dentists and physicians are uncomfortable with these products because the possible benefits and side effects are uncertain. Herbal products are not regulated in the United States, and can make claims of efficacy without formally demonstrating that the product does what it claims. If you use these products, follow the manufacturer’s directions and do a bit of research on your own as to the ingredients and possible side effects.
Baby Bottle Tooth Decay
Early childhood caries, also known as baby bottle tooth decay or bottle rot, is a form of dental disease that is particularly aggressive. It is caused by frequent and long exposure of young teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice, and fruit drinks.
Although it is tempting to put a baby to bed with a bottle containing one of these yummy drinks, it can cause serious, rapid tooth decay. If you must give a bottle to comfort the baby, use only water. If your child is already used to another beverage, and will not go to sleep without it, wean her from it by diluting it with water over the course of one to two weeks.
More tips for preventing disease in young children:
- Wean your child from the bottle to a cup as soon as you can.
- Avoid putting your child to bed with a bottle. If he must use a bottle, fill it only with water.
- Limit the amount of fruit juice that children drink. (Learn more in Good Diet = Healthy Teeth in the Prevention section.)
- After the first tooth erupts, avoid breast feeding at will. It is absolutely still ok to breast feed, just do it for longer periods of time, less often.
- Begin a regular routine of cleaning your child’s mouth, using a moist soft cloth to gently wipe the gums before teeth have come in, and a soft tooth brush after they come in. Please read Home Care in the Prevention section for brushing tips.
Sippy cups should be used as a training tool from the bottle to the cup, and should be discontinued by the time a child is one year old. If your child uses a sippy cup throughout the day, fill it only with water (except at mealtimes). Filling a sippy cup with liquids other than water and allowing a child to drink from it throughout the day bathes the teeth in cavity-causing bacteria, and can lead to severe disease.
Oral Piercing: Is It Really Cool?
Tongue and lip piercing looks cool to some people and helps them feel that they fit in with the crowd they want to emulate. These piercings do have some consequences for your teeth, gums, and overall health that should be considered before you get one.
Unless you are willing to take them out regularly, they are very difficult to clean. It’s a little like having an extra tooth that you can’t brush, which can make your breath smell really bad.
Your mouth has millions of bacteria in it, and oral piercings are a common site for painful infections. Sometimes, these infections can even spread, causing problems with the blood, heart, or brain.
Your lips and tongue are also full of nerves. If one of these nerves is accidentally hit by the piercing itself, or by an infection arising from it, it can lead to a condition called trigeminal neuralgia, which is very painful and very difficult to cure.
As if that wasn’t enough, piercings also place you at higher risk for cracked and chipped teeth, gum disease, and severe oral bleeding. We hope you’ll give your mouth a break by skipping the mouth jewelry.
Tobacco: Bad News In Any Form
Tobacco, no matter what form it is delivered in, is really bad news for your teen’s health. Many teens believe that chewing tobacco is a safe alternative to cigarettes. Unfortunately, that just isn’t true. Teens who use it may be interested to know that one can of chewing tobacco delivers as much nicotine as 60 cigarettes. Studies also show that it may be more addictive than smoking cigarettes. In as little as three months, chewing tobacco can cause gum disease and pre-cancerous lesions.
If you or your child uses tobacco, please watch for the following early signs of oral cancer:
- Leathery patches on the cheeks, lips, or under the tongue. These may be white, red, or purplish.
- Difficulty chewing, speaking, swallowing, or a change in how the teeth fit together.
- Pain, tenderness, or numbness anywhere in the mouth or lips.
Despite that final bullet point, most early oral cancer is not painful, and is therefore ignored. If not addressed in the early stages, oral cancer can cause extensive disfigurement and can require very invasive surgery. It can take away your voice, your ability to eat, and your ability to breathe. Moreover, it can kill you.
Please discuss the consequences of tobacco use with your children and teens. If you need help doing so, feel free to ask us for advice or assistance.
Amazing Advances: When a Root Canal Isn't Enough
There are times when even young children and teens need a root canal in order to give a badly damaged tooth the best chance. However, in permanent teeth that are this young, it is a very delicate procedure, with very different considerations from more mature permanent teeth. Often it requires special procedures and materials to safely clean the inside of the tooth and restore it to function, without causing additional weakening of the tooth.
We thought you would like to know that Dr. Cottam has trained with leading endodontists (dentists who specialize in root canal therapy) to provide the latest, most successful therapies for young permanent teeth.
Now, that’s just awesome!
P.S. Dr. Cottam thinks this stuff is really cool. If you are curious about the specifics of these procedures, just ask… he loves to talk about it!
Our office was designed for infants, children and teens. From the games in the waiting room to the wall art, kids feel right at home. It’s a unique atmosphere that helps children relax and enjoy their experience. Children deserve to experience a gentle, caring approach to their dental care.
Our goal is to help your child grow into an adult who routinely and comfortably seeks dental care. This often requires extra time with your child, distraction through many of our child friendly amenities, or in some cases the use of appropriate sedatives. It is very important to discuss with Dr. Cottam any bad experiences or fears your child may have in order to provide the best possible care for your child.
Dr. Cottam offers nitrous oxide (laughing gas) for the slightly anxious child. Nitrous oxide helps a child who is cooperative but worried about various aspects of their appointment. It helps alleviate anxiety about having instruments placed in the mouth. Nitrous oxide isn’t for everyone, however. It requires a certain amount of cooperation from the child, as they are required to breathe only through a plastic apparatus placed over their nose. If the child is too young or too anxious to sit in a chair and breathe through a nose-piece, nitrous oxide is not an option.
Nitrous oxide is an extremely safe sedation option. When your child is breathing nitrous oxide they are receiving more oxygen than they are getting in room air!
Oral Conscious Sedation
Conscious Sedation provides a safe, effective way to alleviate dental anxiety and provide children with the treatment they need.
Conscious Sedation makes use of a prescription medication that induces a drowsy, relaxed feeling. This is an oral medication and no intra-venous needles are used. Nitrous oxide gas inhalation may be used in conjunction with the sedative to enhance the therapeutic effect. During Conscious Sedation, your child’s vital signs are continuously monitored.
The typical Conscious Sedation experience creates a carefree atmosphere for the patient with most children reporting very little memory of their treatment appointment.
For the patients who are extremely young and who have particularly severe disease, Dr. Cottam offers general anesthesia in a hospital or out-patient setting. This allows full-mouth dental therapy to be rendered in the most gentle way possible in a single visit.
We care about our patients, so if you have any special requests, please let us know how we can better serve you. Our goal is to help your children learn to enjoy and appreciate the dental care that will help keep their smiles bright for a lifetime!